Healthy Credit Practices | Establishing Healthy Credit

home

LOAN ASSISTANCE/CAPITAL ACCESS SERVICES REQUEST - NEWLY ESTABLISHED BUSINESS

Please complete the following information about the credit needs for your newly established business.

Basic Business & Contact Person Information

First Name:

Last Name:

Company:

E-Mail:

Fax:

Adress:

City:

State/Province:

Zip

Business Structure:

Industry:

Annual Revenue:

No. of Employees:

Date Business was Started:

Referred by:

Person: from (Organization)

Business Ownership Information

Select Ethnicity of Business Ownership (51% or more):

Gender:

Tell Us About Your Financing Needs

Loan Amount Sought:

Loan Purpose ( select all that apply):

	New Business Start-up		Business or Franchise Acquisition
	Acquire Equipment/Fixed Assets		Inventory or Receivable Fundin
	Building Purchase or Building Improvements		Business Credit Cards/Trade Credit
	Term loan for General Operating Costs		Expansion Funds

Explain any other specific credit needs

What type of collateral can you pledge?

Have you ever been denied for a loan?

Yes No

Tell us the reasons for prior loan denial:

Who were you denied by:

For Internal Processing Purposes Only - Do Not Complete:

Internal Use Only: